Provider Demographics
NPI:1497953152
Name:JACKSON, FELICIA ATHENS (PHD, MCJ, RN)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ATHENS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD, MCJ, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 BELFAST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2527
Mailing Address - Country:US
Mailing Address - Phone:614-861-0983
Mailing Address - Fax:614-860-0487
Practice Address - Street 1:4634 BELFAST DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2527
Practice Address - Country:US
Practice Address - Phone:614-861-0983
Practice Address - Fax:614-860-0487
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN26987163WC1500X
OHRN269287163WH0200X, 163WP0807X, 163WP0808X, 163WP0809X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult